The Kathmandu Post
24 March 2003

DOTS has cured many and can cure 'you' too

By Perina Pathak

KATHMANDU, March 23

The world observes 'World Tuberculosis Day - 2003' on Monday, with the theme 'DOTS cured me - it will cure you too!'.

Tuberculosis (TB), the leading curable, infectious killer is said to have infected one third of the world's population, with more than 5,000 people dying of the disease each day, mostly in the developing world.

According to Nepal Tuberculosis Association (NTA) about 45 percent of the population is infected with TB, out of which 60 percent are in the productive age group (15 to 49 years). The number of tuberculosis cases in Nepal is still frustratingly high with 8,000 to 11,000 dying of the disease each year.

According to data made available by the NTA, 44,000 new TB cases occur annually, with one in three persons being affected.

Devendra Bahadur Pradhan, President of Nepal Anti-TB Association (NATBA), says that TB kills one person every three hours in Nepal. "However, we are hopeful that the number will decrease under the DOTS (Directly Observed Treatment Short course) treatment," said Pradhan.

Along with the DOTS programme, there is a need for advocacy and awareness programmes with the combined effort of NGOs, INGOs and the government. "If the advocacy programmes are successful the disease can be totally eliminated," opines Pradhan.

Experts say that along with the increase in HIV/AIDS patients, there is an increase in the number of TB patients. It is estimated that among the 60,000 HIV/AIDS patients in Nepal, more than 85 percent are TB infected. "In this region where spread of TB is high, the incidence of HIV/AIDS has further deteriorated the situation," said Pradhan.

"We have planned to bring awareness through those affected, who will advocate that TB can be cured, controlled and, with diligent effort can be eliminated," said Pradhan. "Our main focus will be to mobilise greater access to DOTS treatment."

Despite claims by medical officials that Nepal has achieved over 90 per cent success through the DOTS treatment method, risk factor cannot be ruled out due to the open border with India and free movement of people within the region. UNAIDS has declared the region as a 'Concentrated Epidemic Area' because of the increasing rate of HIV. "Because of the open border, Nepal could be vulnerable to both TB and HIV/AIDS," said Dr. Bhabana Shrestha, of the NATBA.

In the late 19th century, TB killed one out of every seven people in the United States and Europe. On March 24, 1882, Dr. Robert Koch announced the discovery of the TB bacillus. At the time, his discovery was hailed as the most important development in the control and elimination of this deadly disease.

The first World TB Day was organised in 1982, a century after Dr. Koch's discovery. The event was intended to educate the public about the devastating health and economic consequences of TB, its effect on developing countries and its continued impact on global health.

WHO declared Global TB Emergency in 1993. Since then, various attempts have been made to eliminate the disease but TB still kills several thousand people around the world each year. The rise in pollution, congested space, deteriorating sanitation and lack of awareness were cited as some of the reasons for the increasing number of TB deaths.

WHO has targeted diagnosing 70 percent of new infections and curing 85 percent of these, averting 60,000 deaths, over the year 2005, and it has targeted the year 2050 to eliminate the disease altogether.